By Arthur Allen, Kaiser Health News
Thousands of letters full of money flooded Jonas Salk’s mailbox the week after his 1955 polio vaccine was declared safe and effective. Everyone wanted his vaccine. Desperate parents have shut down doctors’ phone lines in search of the precious elixir; medicine companies and doctors took doses down to the rich and famous.
Some of the first batches of the vaccine were disastrous, resulting in 200 cases of permanent paralysis. That hardly lasted public desire for the preventive. Marlon Brando even asked to play Salk in a movie.
Eight years later, with polio becoming a fading threat, the first measurement vaccines went on sale. Measles had killed more than 400 children the year before and caused permanent brain damage in thousands more. Interest in the vaccine was modest. The creator, Maurice Hilleman, was never made lion-like as Salk had been.
‘People felt,‘ What is it all about? I had knives; why does my child need a vaccine? “It was a very difficult sale,” said Walter Orenstein, a Emory University professor who headed the National Immunization Program at the Centers for Disease Control and Prevention from 1988 to 2004.
If a coronavirus vaccine becomes available, will it then be filled with a roaring ovation, such as the polio vaccine, or communal vulture, such as the knives that have been shot? Or some strange hybrid of the two? Americans’ trust in authority, affordable access to the vaccine, and a sense of solidarity will determine the outcome, said Orenstein and other veterans and public health historians.
Perceptions of certain diseases – and vaccines – reflect the seriousness of the diseases themselves, but popular values, culture, human risk assessment and policy all play important roles. The acceptance of public health measures – whether for masks or vaccines – is never fully determined by a rational balance of risk and benefit.
We can see that in the history of national campaigns for new vaccines intended to overcome a plague. No disease became more frightening than polio in the middle of the 20th century. With the possible exception of AIDS, no disease has been feared since the advent of COVID-19.
The polio vaccine was one of the few that greeted the audience. Diseases such as mumps and whooping cough were familiar childhood symptoms. In most years, they killed more children than polio, but polio, which put people in iron lungs and armbands, was seen in ways that a death certificate of a child, hidden in a drawer, could never be.
Vaccines are often a hard sell because they are more likely to occur than cure disease and look scary, although they are generally fairly safe. Since vaccines should be used extensively to prevent outbreaks, successful vaccination campaigns place a great deal of trust in those who sell, recommend and manage the drugs. And confidence in science, government and business has not always been in constant supply.
In the late 1800s and early 1900s, when public health laws were in flux, authorities fighting pox epidemics would often send vaccinators with the police to enforce the jab. They would enter factories where reports were reported, lock the doors and kick the workers through a fax line. The resistance of the workers was not unmerited; the vaccine sometimes causes swollen arms, fever, and bacterial infections. Vaccination could cost a missed salary a week.
Authorities had learned their lesson by the 1920s, when the diphtheria vaccine came on the scene, as James Colgrove noted in his book State of Immunity: The Politics of Vaccination in Twentieth Century America. Diphtheria was a much feared killer of children, and publicity campaigns carried out by public health, insurance, and charity officials sought to be believed and persuaded rather than coerced.
Polio shocked Americans, reaching a peak in 1952 with more than 57,000 cases. In 1938, President Franklin D. Roosevelt, himself a polio patient, began a national science program to combat the disease, supported by millions of American contributions through the March of Dimes.
The result of this national search, uniting the government and the people, was Jonas Salk’s inactivated polio vaccine. It cemented a strong confidence after World War II in the American scientific and medical institution that would last for many years.
Social solidarity was also important.
Vaccines prevent the circulation of a disease during vaccination through what scientists call herd immunity – if enough people are vaccinated. When a reliable rubella vaccine became available in 1969, states quickly required vaccination for children, even though rubella was virtually harmless to children. They wanted to protect a vulnerable population – pregnant women – in order to prevent a recurrence of the 1963-64 congenital rubella epidemic, which resulted in 30,000 fetal deaths and the birth of more than 20,000 babies with severe disabilities.
The embrace of the rubella vaccine, as historian Elena Conis of the University of California-Berkeley notes in her book, Vaccination: America’s Changing Relationship with Immunization, marked the first time a vaccine had been deployed that did not offer a direct benefit to those who were vaccinated.
Yet it took a combination of fear, solidarity, and coercion for Orenstein and his colleagues at the CDC and State of Public Health for agencies to increase vaccination rates for children for mumps, whooping cough, rubella, and diphtheria up to 90 percent and more in the 1990s. driving ensures herd immunity.
Shame was also a tool. Orenstein recalled the testimony of the Florida legislature when he considered a smarter fax mandate. He showed them that disease rates were lower in neighboring states that had stricter mandates. It worked.
What else is there? In a politically divided nation, confidence in science is low and experts are becoming distrustful – politicians more so. Efforts for childhood vaccination are already being contaminated by large numbers of hesitant parents. And efforts to combat the COVID epidemic in the United States have been at best loud and chaotic, leaving Americans doubting the competence of their governments and institutions.
There is still fear. “Maybe I’m an old-fashioned fool, but I think most people would welcome a vaccine if the startup is done right,” said David Oshinsky, a professor of history at New York University and author of Polio: An American Story, a history of the Pulitzer Prize-winning. “Most people are desperate for COVID. A minority thumb their noses, many of them for political reasons. How will this change if there is a fax [hopefully] does the comparison of health risks change to any degree? ”
Recent studies show that less than half of Americans are vaccinated against COVID-19. Those numbers could change depending on a number of difficult-to-predict factors, said Conis, of Berkeley.
“A lot of people will really like it,” she said. “Many will doubt, not only because of incorrect information, but because of a lack of confidence in the current administration.”
When a coronavirus vaccine is introduced, it can be sold as personal protection, even for young, healthy people. But those who suffer most from the virus are usually older than sure. An effective vaccination campaign can try to affirm a sense of solidarity, or altruism, as well as a more general meaning that the economy without vaccination will not be able to get back on its feet.
“I’m not clear if people accept that solidarity,” Orenstein said. “People are looking more for what is good for themselves than what is good for society.” That said, the risk of COVID-19 for young people is “not zero. That’s one of the most important ways to sell it in a sense.”
KHN (Kaiser Health News) is a nonprofit news service that deals with health issues. It is an editorially independent program of KFF (Kaiser Family Foundation) which is not affiliated with Kaiser Permanente.
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